Sutures versus clips for skin closure following caesarean section: a systematic review, meta-analysis and trial sequential analysis of randomised controlled trials

Zaman, Shafquat; Mohamedahmed, Ali Yasen; Peterknecht, Elizabeth; Zakaria, R M; Mohamedahmed, Saeed Y Y; Hajibandeh, Shahab; Hajibandeh, Shahin

doi:10.1007/s00423-021-02239-0

Cited by 4 publications

(4 citation statements)

References 25 publications

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“…The overview includes 38 SRs 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 (16 Cochrane and 22 non-Cochrane) published between 2004–2024 involving 628 RCTs with a total of 190,349 participants. Table 1 summarises the main characteristics of the included SRs (see Annex 4 for details).…”

Section: Resultsmentioning

confidence: 99%

“…RTC/No. participants) Certainty of evidence Category Technique s and materials Fascia and muscle layers closure Subcutaneous closure 58 , 59 Subcutaneous tissue closure Non-closure Seroma formation 0.53 [0.33, 0.84] (8/1979) High Any type of wound complications 0.66 [0.47, 0.93] (10/3811) High Wound infection 1.02 [0.69, 1.50] (5/1348) Moderate Endometritis 0.77 [0.46, 1.28] (1/590) Moderate Blood loss (mL) 9.00 [−24.29, 42.29] (1/590) Moderate Haematoma formation 0.74 [0.22, 2.42] (7/1663) Moderate Duration of surgery (min) 0.60 [−2.29, 3.49] (1/590) Moderate Skin closure 60 , 61 , 62 , 63 , 64 Subcuticular PGA absorbable suture Interrupted nylon suture Hypertrophic scar at 6 months 1.85 [1.33, 2.58] (1/65) Low Subcuticular barbed suture Subcuticular PDS suture Wound infection 0.96 [0.18, 5.10] (1/188) Low Wound complication 1.44 [0.30, 6.93] (1/188) Low Time skin closure (min) 0.60 [−0.30, 1.50] (1/188) Low Conventional sutures Combined postoperative morbidity 0.88 [0.46, 1.65] (1/188) Very Low …”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews

Gialdini,

Chamillard,

Diaz

et al. 2024

eClinicalMedicine

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews

Gialdini,

Chamillard,

Diaz

et al. 2024

eClinicalMedicine

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“…Further, our clips vs. suture model demonstrated an accuracy of >93% accuracy, and our temporal trend analysis showed a preference for using sutures for wound closure. Various studies have concluded that suturing is more efficient when compared with the use of clips for good wound closure, resulting in lower rates of separation, prevention of SSI, and ultimately shorter hospital LOS ( 41 , 42 ). Contrastingly, postoperative analysis of visual analogue pain scores comparing the use of clips to non-absorbable sutures have also demonstrated a significantly quicker and pain-free experience for patients with stapled wounds ( 43 ).…”

Section: Discussionmentioning

confidence: 99%

Natural language processing for the automated detection of intra-operative elements in lumbar spine surgery

Biswas,

McMenemy,

Sarkar

et al. 2023

Front. Surg.

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BackgroundThe aim of this study was to develop natural language processing (NLP) algorithms to conduct automated identification of incidental durotomy, wound drains, and the use of sutures or skin clips for wound closure, in free text operative notes of patients following lumbar surgery.MethodsA single-centre retrospective case series analysis was conducted between January 2015 and June 2022, analysing operative notes of patients aged >18 years who underwent a primary lumbar discectomy and/or decompression at any lumbar level. Extreme gradient-boosting NLP algorithms were developed and assessed on five performance metrics: accuracy, area under receiver-operating curve (AUC), positive predictive value (PPV), specificity, and Brier score.ResultsA total of 942 patients were used in the training set and 235 patients, in the testing set. The average age of the cohort was 53.900 ± 16.153 years, with a female predominance of 616 patients (52.3%). The models achieved an aggregate accuracy of >91%, a specificity of >91%, a PPV of >84%, an AUC of >0.933, and a Brier score loss of ≤0.082. The decision curve analysis also revealed that these NLP algorithms possessed great clinical net benefit at all possible threshold probabilities. Global and local model interpretation analyses further highlighted relevant clinically useful features (words) important in classifying the presence of each entity appropriately.ConclusionsThese NLP algorithms can help monitor surgical performance and complications in an automated fashion by identifying and classifying the presence of various intra-operative elements in lumbar spine surgery.

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“…There is controversy about the way of skin closure after cesarean delivery. Previous meta-analysis shows that absorbable suture reduces the risk of skin separation compared with suture staple, but increases the time of wound suture [ 7 – 9 ]. Compared with suture, the barbed suture reduces the time to skin closure of dermal and epidermal layer and total operative time without increasing blood loss or maternal incidence rate [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effect of skin closure materials on skin closure during cesarean delivery

et al. 2022

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Objective To compare the effect of skin closure materials on skin closure during cesarean delivery. Methods We searched EMBASE、PubMed、Scopus、Cochrane CENTRAL for randomized controlled trials (RCTs) on the use of closure materials for skin closing effect during cesarean delivery. The outcomes were time to skin closure of dermal and epidermal layer, skin separation rate and wound complications(wound infection, hematoma,seroma, reclosure, readmission) reported as an odds ratio (OR) and surface under the cumulative ranking curve analysis (SUCRA) score. Results Twenty -six RCTs met the inclusion criteria. In the network meta-analysis (NMA) for time to skin closure of dermal and epidermal layer, pooled network OR values indicated that staple (network SMD, -337.50; 95% CrI: -416.99 to -263.18) was superior to absorbable suture. In the Skin separation NMA, pooled network OR values indicated that the absorbable suture (network OR, 0.37; 95% CrI: 0.19 to 0.70) were superior to staple. In the wound complications NMA, pooled network OR values indicated that the no interventions were superior to staple. Conclusion In conclusion, our network meta-analysis showed that the risk of skin separation with absorbable suture after cesarean delivery was reduced compared with staple, and does not increase the risk of wound complications, but the wound closure time would slightly prolonged.

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Sutures versus clips for skin closure following caesarean section: a systematic review, meta-analysis and trial sequential analysis of randomised controlled trials

Cited by 4 publications

References 25 publications

Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews

Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews

Natural language processing for the automated detection of intra-operative elements in lumbar spine surgery

Comparison of the effect of skin closure materials on skin closure during cesarean delivery

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